Stepping Up Patient Assessment: Part III

By: Anonymous on 11:58:00 AM

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This is the final post in a series of three meant to highlight the increasing importance of patient assessment for pharmacists.  Each post was written to illuminate how pharmacists can help address a number of public health issues.  Specifically, Part I was devoted to pharmacists taking on a greater role to help with medication adherence.  Part II emphasized the contributions pharmacists make in reducing falls risk among patients; and now Part III, the last installment in the series, will serve as a call to action for pharmacists to help address the growing problem of substance abuse.

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You’d have to be living under a rock not to know that substance abuse is a major public health crisis in the United States.  After all, it has even spilled over into the 2016 presidential election campaigns.

According to the National Institute on Drug Abuse, alcohol and tobacco remain the most common and costly substances of abuse for our healthcare system.  However, what has elevated substance abuse to an epidemic level is the increasing use of opioids, such as heroin and prescription pain relievers.  

This year in the January 1 Morbidity and Mortality Weekly Report (MMWR), the CDC revealed a 15-year, 200% increase in the rate of overdose deaths due to opioids; and specifically during 2014, with the exception of children < 15 years of age, every age group, including the elderly (> 65 years) showed a rise in opioid-related deaths.  In addition this MMWR indicated a 3-fold rise in heroin overdoses since 2011.  

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Over the past decade training and continuing education for pharmacists regarding substance abuse has primarily focused on building awareness and calling on pharmacists to report abuse to the prescriber and law enforcement, as well as utilize their state’s prescription drug monitoring program (PDMP) to help reduce abuse and diversion.  More recently, pharmacists have procured greater access and ability to help patients obtain naloxone.  (More to come on Naloxone in a future post.)

In the spirit of pharmacists seeking our rightful recognition as healthcare providers, I believe there is an even greater role that pharmacists can serve in helping address and reduce the risk of substance use disorders.  You guessed it! It has to do with stepping up our role through assessment and intervention. 

I was recently awarded a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) for my institution, Shenandoah University.   We are using an interprofessional approach to deliver Screening, Brief Intervention & Referral for Treatment (SBIRT) training to health professionals and graduate health professions students.  We are one of only a few grantees emphasizing the importance of training pharmacists in SBIRT.  

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You might be thinking, “why would pharmacists want this training”?  Our accessibility to the public and our ability to establish rapport with patients is key.  Addiction is a disease, but it stems from poor choices and behaviors.  Pharmacists have been successful in using motivational interviewing to help with behavioral change such as with smoking cessation.  In the end, particularly since the greatest predictor for heroin use is a previous misuse of prescription opioids,  if we are not assessing for the risk of substance use disorders, then we are part of the problem.   For these reasons, pharmacists are strongly positioned to make a difference. 

In northwestern Virginia, where Shenandoah University is located, and where deaths from

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heroin and other opioids have steadily climbed, the hope is that pharmacists, trained in SBIRT, and on the front-line of healthcare will be able to help identify patients at risk and provide life-saving, timely intervention. 

I welcome your comments.  Is monitoring the PDMP enough? Are you SBIRT trained?  Tell me what you think of the pharmacist’s role in SBIRT for substance abuse prevention and intervention.  Can we make a difference?